Combatting the Third Opioid Crisis: Fentanyl

What history teaches us about the opioid cycle

Kim Sullivan, who's son (in photo), died of a heroin overdose, prepares to address students at Fitch Senior High School to educate teens about the dangers of opioid painkiller medication and heroin addiction on Feb. 26, 2016 in Groton, Conn. (John Moore/Getty Images)

NEW YORK—Every day, more than 115 people in the United States die from opioid overdose, according to a database from the National Institute on Drug Abuse (NIDA).

“In New York City, more people die from drug overdose than they do from homicide, suicide, and motor vehicle crashes combined,” said Dr. Denise Paone, senior director of research and surveillance in the Bureau of Alcohol and Drug Use Prevention, Care and Treatment at the New York City Department of Health and Mental Hygiene.

While the opioid crisis has reached an extreme, it’s not the first time we’ve seen this—it’s in fact the third opioid crisis since the blossoming of modern medical research over 300 years ago. Each crisis arose after a new painkiller was formulated by researchers who thought it would be more effective and less addictive than the problem drug of the time.

Today’s big killer is synthetic fentanyl, a drug 50 to 100 times more potent than morphine. Its discovery in the late 1970s as a powerful alleviator of chronic pain led to a dramatic increase in sales and prescriptions.

It was the same story for morphine, heroin, and opium, just a few of the drugs invented before fentanyl.

Local police and paramedics help a man who is overdosing in the Drexel neighborhood of Dayton, Ohio, on Aug. 3, 2017. (Benjamin Chasteen/The Epoch Times)

One Opioid Crisis After Another

Opioids are a class of drugs that includes morphine, heroin, codeine, the synthetic drug fentanyl, oxycodone (trade name OxyContin), and many others. Some of these drugs are illegal, and some are pain relievers available legally by prescription.

The first opioid—opium—came to the United States in the 18th century. Opium was first used by physicians therapeutically to relieve cancer pain and other applications, according to Methamphetamine and Other Illicit Drug Education, an information resource from the University of Arizona.

The addictive nature of opium was only recognized toward the end of the 18th century. This was the start of the first opioid crisis.

Morphine—which is 10 times more euphoric than opium—was isolated from opium in 1805. At first, it was seen as a way to cure opium addiction, but over time, morphine abuse increased.

In hopes of finding an alternative to the highly addictive morphine, a British chemist, C.R. Alder Wright, discovered heroin in 1874 by chemically altering morphine.

German pharmaceutical company Bayer starting manufacturing heroin in 1898. By the 1920s, it was fueling so much crime and addiction in the United States, that it was classified as an illegal drug. This was the second opioid crisis.

The latest killer, fentanyl, was first synthesized in Belgium in 1960 by Dr. Paul Janssen of the pharmaceutical company Janssen.

Fentanyl is a very short-acting and highly potent synthetic opioid. According to Paone, it is 50 to 100 times more potent than morphine.

Fentanyl sales increased about 10-fold in the first year (1981) after the drug’s initial patent wore off, and in 2004, sales exceeded $2.4 billion in the United States. Today it is responsible for an estimated 60 percent of drug deaths according to NIDA’s 2018 database.

‘Drugs Dealers in White Coats’

On Oct. 11, the Manhattan U.S. Attorney Geoffrey S. Berman charged five doctors and two other medical professionals with illegally distributing oxycodone, another popular opioid for pain relief.

“[I]nstead of caring for their patients, they were drug dealers in white coats,” said Berman in the press release.

On July 1, a new law went into effect limiting opioid prescriptions for acute pain to one week’s supply.

“There was definitely many, many, many prescriptions written that probably should not have been,” said Paone.

Many drug addictions start with opioids prescribed as painkillers. And in other cases, patients would sell opioids obtained via prescription to others for profit.

When the prescription drug gets too expensive, patients go for a cheaper alternative available on the streets—usually heroin or cocaine mixed with fentanyl.

Given the amount of fentanyl varies in every batch, this can easily lead to overdosing.

“Every 6 hours someone dies of a drug overdose,” said Paone, adding that 82 percent involve some type of opioid—half of which are fentanyl.

House Energy and Commerce Committee Chairman Rep. Greg Walden (R-OR) with a photograph of Amanda Beatrice Rose Gray, who died from an opioid overdose, during a news conference on Capitol Hill on June 13, 2018, in Washington. (Zach Gibson/Getty Images)

Sweeping Federal Bill Seeks to End Crisis

In October 2017, President Trump declared the opioid crisis a national public health emergency.

Less than a year later, the Senate passed the SUPPORT for Patients and Communities Act (H.R. 6) with an overwhelmingly (and rare) bipartisan vote of 98-1. It is currently on the president’s desk to sign.

The act includes a sweeping array of 58 bills to advance recovery and treatment initiatives, and to prevent drugs from getting into people’s hands in the first place. It also includes research into non-opioid alternatives for the treatment of pain.

“While there is still much work to be done, this historic effort will undoubtedly save lives and put families and communities across our country on the road to recovery,” said Rep. Greg Walden (R-OR), a sponsor of the act.